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Individual
TERRY REYNOLDS
Active
Individual
TERRY REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-03520
NC
363A00000X
Physician Assistant
Primary
PA3597
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291118300
—
FL
01
—
E3618
MEDICARE CORE
FL
Enumeration date
10/15/2005
Last updated
01/03/2013
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